March 25, 2013Clinical Cardiology138 citationsOpen Access
View Full PaperTricuspid Regurgitation in Patients With Pacemakers and Implantable Cardiac Defibrillators: A Comprehensive Review
Structured PICO
What are the mechanisms, incidence, and treatments for tricuspid regurgitation associated with implantable cardiac devices?
P
Population
Patients with pacemakers and implantable cardiac defibrillators
I
Intervention
Implantable cardiac devices (defibrillators and pacemakers)
O
Outcome
Incidence, mechanism, and treatment of lead-related tricuspid regurgitation
This review highlights that pacemaker and defibrillator leads can cause or worsen tricuspid regurgitation through mechanical or electrical mechanisms, necessitating careful diagnosis and management.
Abstract
Implantable cardiac devices, including defibrillators and pacemakers, may be the cause of tricuspid regurgitation (TR) or may worsen existing TR. This review of the literature suggests that TR usually occurs over time after lead implantation. Diagnosis by clinical exam and 2-dimensional echocardiography may be augmented by 3-dimensional echocardiography and/or computed tomography. The mechanism may be mechanical perforation or laceration of leaflets, scarring and restriction of leaflets, or asynchronized activation of the right ventricle. Pacemaker-related TR might cause severe right-sided heart failure, but data regarding associated mortality are lacking. This comprehensive review summarizes the data regarding incidence, mechanism, and treatment of lead-related TR.